=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275797409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LTP GENERATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2008
-----------------------------------------------------
Last Update Date | 01/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 MACARTHUR BLVD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94610-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-836-3777
-----------------------------------------------------
Fax | 510-836-0516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1297
-----------------------------------------------------
City | ALAMO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94507-7297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-836-3777
-----------------------------------------------------
Fax | 510-836-0516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LETICIA PANIS PEREZ
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 925-837-7068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------